Failure to de-arouse during sleep-onset transitions in the heart rates of individuals with sleep-onset insomnia

Hsin Jung Tsai, Terry B.J. Kuo, Kuan Liang Kuo, Cheryl C.H. Yang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: Increased cardiovascular risk associated with sleep-onset insomnia has been reported, but the patterns of heart rate (HR) transitions during sleep onset in individuals with sleep-onset insomnia remain uncertain. This study explored the HR dynamics during objective and subjective sleep onset transitions among sleep-onset insomnia. Methods: Seventeen good sleepers and 17 individuals with sleep-onset insomnia had their night-time HR measured. HR and heart rate variability (HRV) were analyzed within 8-min periods of pre- and post-transition of stage N1, stage N2 and subjective sleep onset. Results: A significantly higher low-frequency percentage of HRV was observed in pre-N1 period among insomnia group, compared with good sleepers. Decline in HR begins in 160 s prior to N1 onset among good sleepers, whereas the HRs of insomnia group were reduced only after N1 onset in comparison to their HRs at the time of N1 onset. The good sleepers and insomnia group both had their HRs dropped to a level comparable to their HRs at respective stage N2 onset at 220 s and 80 s prior to N2 onset. No differences in HR was found during subjective sleep onset transition in both groups. Conclusion: During the wake-to-sleep transition, a low and stable HR was observed before cortical alternations in good sleepers; however, a consistently high HR until N1 onset was shown among sleep-onset insomnia. This finding suggests a state-dependent and failure to de-arouse from the high arousal level of wakefulness into light sleep is associated with sleep initiation difficulty.

Original languageEnglish
Article number109809
JournalJournal of Psychosomatic Research
StatePublished - Nov 2019


  • Heart rate
  • Insomnia
  • Sleep initiation difficulty
  • Wake–sleep transition


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